<form id="edit-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Opt_date')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-opt_date" class="form-control datetimepicker" data-date-format="YYYY-MM-DD" data-use-current="true" name="row[opt_date]" type="text" value="{$row.opt_date}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Jiumao')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-jiumao" class="form-control" name="row[jiumao]" type="text" value="{$row.jiumao|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Yijianwei')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-yijianwei" class="form-control" name="row[yijianwei]" type="text" value="{$row.yijianwei|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Zhongming')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-zhongming" class="form-control" name="row[zhongming]" type="text" value="{$row.zhongming|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Zhuoda')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-zhuoda" class="form-control" name="row[zhuoda]" type="text" value="{$row.zhuoda|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Wuhai')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-wuhai" class="form-control" name="row[wuhai]" type="text" value="{$row.wuhai|htmlentities}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Shouli_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-shouli_id" data-rule="required" data-source="shouli/index" class="form-control selectpage" name="row[shouli_id]" type="text" value="{$row.shouli_id|htmlentities}">
        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-primary btn-embossed disabled">{:__('OK')}</button>
        </div>
    </div>
</form>
